Neonatal outcomes in twin pregnancies with the first twin in breech presentation according to the mode of delivery: A cohort study from Dakar Senegal.

The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight <= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process.

[Unadjusted and customized fetal growth curves: a comparative study in a sub-Saharan population]. / Courbes de croissance fœtale non ajustées et personnalisées: une étude comparative dans une population du Sud du Sahara.

The purpose of this study was to compare the unadjusted EPOPé M0 curve with the customized Gardosi curve in the diagnosis of small-for-gestational-age (SGA) fetuses in a sub-Saharan population. We compared the Gardosi et al. and EPOPé M0 classifications. Classification differences were analyzed according to patient characteristics and obstetric conditions. Data collected from FileMaker software were analyzed using SPSS 20.0 and R Studio software. The statistical tests were carried out according to applicability conditions. Alpha risk was set at 0.05. The Gardosi curve showed that the rate of SGA newborns was higher (31.4% versus 28.9%) and did not differ between overweight and normal-weight women. The rate of severe SGA in preterm infants was also higher (23.6 versus 19.7%). Diseases were more frequent in newborns classified as severe SGA by the customized growth curve. The customized curve is recommended for the sub-Saharan Africa population.